Department of Anaesthesiology, University of Heidelberg, Heidelberg, Germany.
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Langenbecks Arch Surg. 2021 Aug;406(5):1283-1294. doi: 10.1007/s00423-021-02078-z. Epub 2021 Feb 1.
Tumour growth and the formation of metastases are essential elements in the progression of cancer. The centre of treatment is the surgical resection of primary solid tumours. But even if the tumour can be removed without microscopic residual cells, local recurrences and distant metastases occur and determine the patient's fate. During the operation, tumour cells are shed from the primary tumour and released into the circulation. These circulating tumour cells might play an important role in the formation of new tumour sites. Therefore, a functional innate and adaptive immune system is essential, especially in this perioperative period. Anaesthesia influences consciousness and pain perception and interacts directly with the immune system and tumour cells.
Review of the current literature concerning intra- and postoperative anaesthetic decisions and tumour progression.
There are beneficial aspects for patient survival associated with total intravenous anaesthesia, the use of regional anaesthetics and the avoidance of allogeneic red blood cell transfusions. Alternatives such as irradiated intraoperative blood salvage and preoperative iron supplementation may be advantageous in cases where transfusions are limited or not wanted. The immunosuppressive properties of opioids are theoretical, but strong evidence to avoid them does not exist. The application of nonsteroidal anti-inflammatory drugs and postoperative nausea and vomiting prophylaxis do not impair the patient's survival and may even have a positive effect on tumour regression.
Anaesthesia does play an important part in the perioperative period in order to improve the cancer-related outcome. Further research is necessary to make more concrete recommendations.
肿瘤生长和转移的形成是癌症进展的重要因素。治疗的核心是原发性实体瘤的手术切除。但即使肿瘤可以在没有显微镜下残留细胞的情况下切除，局部复发和远处转移仍会发生，并决定患者的命运。在手术过程中，肿瘤细胞会从原发性肿瘤脱落并释放到循环系统中。这些循环肿瘤细胞可能在新肿瘤部位的形成中发挥重要作用。因此，一个功能性的先天和适应性免疫系统是必不可少的，特别是在这个围手术期。麻醉会影响意识和疼痛感知，并直接与免疫系统和肿瘤细胞相互作用。
回顾有关术中及术后麻醉决策与肿瘤进展的现有文献。
全静脉麻醉、使用区域麻醉和避免异体红细胞输血与患者生存的有益方面相关。在输血受限或不希望输血的情况下，如辐照术中血液回收和术前补铁等替代方法可能是有利的。阿片类药物的免疫抑制作用是理论上的，但没有确凿的证据表明要避免使用它们。非甾体抗炎药和术后恶心呕吐预防的应用不会损害患者的生存，甚至可能对肿瘤消退产生积极影响。
麻醉在围手术期确实起着重要的作用，以改善与癌症相关的结果。需要进一步的研究来提出更具体的建议。
